脑转移瘤的X-刀治疗（附23例报告）

目的：总结我院用X-刀治疗脑转移瘤的经验。方法：以Bmin Scan Ⅱ型X-刀治疗脑转移瘤病人23例，共38个病灶。治疗计划为：病灶体积为1340±9．35cm^3，等中心数目1至3个不等，准直仪直径为10～40mm，中心剂量为22.25=3.24Gy，肿瘤边缘剂量为15.75=2.93Gy。其中17例加作了全脑放射治疗。结果：随访852±354个月，病灶经X-刀治疗后局部控制率为89．47％。病人因脑转移瘤而产生的症状均明显改善或消失，其平均生存时间为788±324个月，加作全脑放疗的平均生存时间明显较单纯X-刀治疗为长。未发现放射性水肿、坏死及自发性瘤内出血等严重的并发症。已死亡8例，死亡原因与X-刀所治疗的转移灶无关。结论：X-刀或其它立体定向放射神经外科是治疗脑转移瘤的良好方法，但应慎重选择适应证，加强术后处理．并结合其它治疗手段。     

X-刀治疗颅内疾病128例报告

应用X-刀治疗颅内巨大肿瘤及脑血管畸形128例，以中、小病灶为主，亦可作为颅内巨大肿瘤综合治疗的一部分，强调了最大剂量与覆盖剂量比及治疗体积与靶体积比两项比值的重要性。治疗效果的观察，早期主要靠CT扫描检查，一般表现为肿瘤部分失增强效应。     

脑面血管瘤病继发性癫痫的外科治疗（附6例报告）

目的 总结脑面血管瘤病继发性癫痫的外科治疗经验。方法 回顾性分析2008年6月至2014年8月手术治疗的6例脑面血管瘤病继发性癫痫的临床资料,术前行头颅CT、MRI及视频脑电图检查评估,手术切除病灶后随访评估疗效。结果 软脑膜血管瘤病损脑叶切除术3例,软脑膜血管瘤病变及前颞叶切除术1例,改良大脑半球切除术2例,术后随访3个月至6年,6例均为EngelⅠ级,总体癫痫控制良好。结论 结合临床表现及头颅CT、MRI的影像学特征,可明确诊断脑面血管瘤病;继发药物难治性癫痫时,应尽早行癫痫外科治疗,完全切除致痫灶可有效控制癫痫,防止反复癫痫发作对脑功能的进一步损害。     

癫痫的外科治疗（附69例报告）

痫灶切除是提高疗效的关键，本文介绍寻找痫灶的体会。指出前颞叶切除、选择性杏仁核海马切除，胼胝体前部切开合并扣带回毁损，扩展了癫痫外科治疗的范围，并收到较好疗效。     

颅脑疾病的X-刀治疗(附100例临床报告)

目的回顾性分析100例颅脑疾病X-刀治疗后的临床及影像学变化.方法利用JZ-100X刀系统常规固定头环及立体定向头架,3mm层厚CT扫描,将影像信息输入计算机工作站进行三维重建,采用单次或分次治疗.全组72例获得3～27个月的随访,中位15个月.结果70例生存期超过6个月,占随访人数的97.2%,18例超过24个月占25%.40例CT或MRI复查病灶明显缩小占57.1%.结论X-刀治疗颅脑疾病疗效是肯定的,它适合颅内多种类型肿瘤和脑血管畸形及功能性病变治疗.     

重视和规范继发性癫痫的治疗

根据WHO最新调查：我国有癫痫患者900万、活动性癫痫600万左右,且还以每年45万的新患者数增长.过去由于诊断手段所限,不少继发性癫痫病人被诊断为原发性癫痫;近10余年来随着辅助检查技术的进步,这些病人的病因相当一部分得以明确,因此继发性癫痫的比例愈来愈高.     

X-刀治疗颅内海绵状血管瘤14例

目的　探讨X 刀治疗颅内海绵状血管瘤的有效性。方法　以X 刀治疗 1 4例海绵状血管瘤 ,体积为 0 5～ 9 1cm3(平均 3 3cm3) ,病变中心剂量为 1 5～ 30Gy,周边平均剂量为 1 8 7Gy(1 3～ 2 8Gy)。结果　随访 1 3～ 54个月 (平均 37 4个月 ) ,病变大小不变 8例 ,缩小 6例 ,无病变增大者。临床症状改善 1 0 / 1 4 (占 71 4% ) ,3例出现迟发放射性脑水肿 ,1例发生 2次轻度瘤卒中。结论　X 刀治疗深部及功能区部位的海绵状血管瘤是安全有效的 ,对控制病变生长、缓解临床症状有较好的作用     

X-刀治疗颅内疾病的并发症分析

目的：总结X－刀治疗颅内疾病的并发症。方法：以X－刀治疗颅内疾病158例,随访25．3±9．2个月,根据神经系统损害的症状和体征,结合影像检查,以判断是否发生并发症,并分析其原因。结果：总有效率为80．42％,共有14例发生并发症。其中9例为急性反应,5例为迟发性并发症。结论：立体定向放射神经外科虽然有较好的疗效,但也可能产生并发症。急性并发症主要与病灶部位有关,一旦发生可采取对症处理;而迟发性并发症则主要与病灶体积有关,应通过选择适应证及适当的治疗方法尽可能地避免。     

顽固性癫痫的外科治疗（附51例报告）

报告经外科治疗的顽固性癫痫５１例，其中常规手术治疗４９例，经Ｘ－刀治疗２例，对随访时间超过一年的４０例进行评定，有效率为８７．５％，文中结合资料对手术适应证手术方式，致痫灶定位的切除进行了讨论。     

脑血管畸形的X刀治疗（附45例临床分析）

目的总结X刀治疗脑血管畸形效果.方法脑动静脉畸形(AVM)31例,脑海绵状血管瘤14例.单独用X刀治疗39例,AVM血管内栓塞治疗后畸形血管残留X刀治疗3例,脑内血肿清除术后X刀治疗3例.X刀治疗畸形血管周边剂量平均23.04±3.75Gy,其中AVM平均22.6±3.8Gy,海绵状血管瘤平均为24.0±3.9Gy,一般均以70%～90%等剂量线覆盖畸形血管边缘,准直器照射口径10～40mm.结果经12个月～60个月随访,平均随访35.35±17.60个月.复查发现AVM完全闭塞18例,部分闭塞11例,无闭塞2例.海绵状血管瘤X刀治疗后无发生脑出血,大多数患者癫痫可缓解发作,但血管瘤无一例消失.出现症状性放射性脑水肿6例,均为AVM患者.结论AVM闭塞率与所采用的剂量和畸形血管大小相关,剂量越大,闭塞的可能性也越大,对较大的AVM,由于采用的剂量相对较小,闭塞率也较低.直径越小,采用的剂量可适当增加,畸形血管闭合可能性越大,周边脑组织接受剂量较小,对脑组织损伤轻,并发症低.对较大AVM可先进行栓塞,对残留的AVM进行X刀治疗.     

Childhood Secondary (Symptomatic) Epilepsy, Seizure Control, and Intellectual Handicap in a Nontropical Region of South Africa

PURPOSE: To determine the prevalence of secondary (symptomatic) epilepsy and to ascertain levels of seizure control and intellectual function in a clinic population of children drawn from a poor community in a temperate region of South Africa. METHODS: Detailed review of the records of every child with recurrent seizures who attended a special epilepsy outpatient clinic during 1995. RESULTS: A total of 1,017 children was studied. In 432 (43%), there was historic, clinical, and radiologic evidence to suggest that epilepsy was symptomatic of underlying brain damage or defect. Acceptable seizure control was maintained with a single standard anticonvulsant drug (AED) in 65% of cases. In the 6 months preceding the study, 37% of the subjects had remained seizure free. Forty-seven percent of the study population were considered to be of subnormal intelligence. CONCLUSIONS: In a children's hospital outpatient population in the Western Cape region of South Africa, the prevalence of secondary epilepsy is higher than is found in developed countries. There is need within the community for preventive measures aimed at reducing the prevalence of perinatal insults, meningitis, tuberculosis, neurocysticercosis, and cerebral trauma.     

The Axial Spasm—The Predominant Type of Drop Seizure in Patients with Secondary Generalized Epilepsy

In 45 patients suffering from secondary generalized epilepsy, we have recorded 239 drop seizures both by radio-telemetered EEG/split-screen video taping and polygraphically. Twenty of these patients had pure tonic drop seizures. Nine patients each had myoclonic-atonic or pure atonic seizures, whereas seven had slow falls that occurred during gradually developing tonic or akinetic seizures. We term the pure tonic drop seizure "axial spasm." It consists of a uniform pattern of movement lasting from 0.5 to 0.8 s and leading to a specific bearing characterized by a moderate flexion of the hips, the upper trunk, and the head. The arms are almost always involved being abducted, elevated and in a semiflexed position. A fall is provoked by the rapidity and violence of the flexion in the hips. The spasms can occur independently (pure axial spasm) or in connection with other seizure manifestations (combined axial spasm). In pure spasms, no disturbance of consciousness and no significant EEG changes--apart from a slight attentuation--are seen. In the combined axial spasms, distinct epileptic phenomena, in close connection with the axial spasms, can be observed, appearing either in the postspasm phase or in both the pre- and the afterphases. The prephase consists always of an absence and spike-and-wave activity. The onset of the spasm coincides with the last generalized spike, which is followed by a biphasic high-voltage slow wave. In the afterphases, various seizure patterns can be seen; quite characteristic are arrest states during which the patients are completely immobile and take up a postural-like or athetoid position. Almost as frequent are absences or absence-like states and tonic seizures. The afterphase can be compounded by two or three of these seizure patterns, the most common sequence of events in these cases being tonic--arrest state--absence. From the clinical and neurophysiological points of view, axial spasms can be regarded as a more mature form of infantile spasms. Clinical and experimental findings suppose a brainstem origin.     

血管内栓塞联合γ刀治疗脑动静脉畸形

目的 分析血管内栓塞联合γ刀治疗脑动静脉畸型（AVM）的治疗效果及适应证和并发症。方法 自1997年4月-2000年11月我们对46例脑动静脉畸形患者施行血管内栓塞联合γ刀治疗手段。先使用氢丙烯正丁酯（Bucrylate,NBCA)栓塞动静脉畸形，使体积缩小，对高血流体积较大者，采取分次逐步栓塞。所有病例在最后一次血管内治疗一周后行γ刀治疗，在MRI定位下，确定AVM的大小和边界，根据病灶大小，部位和类型设计照射的靶点位置，靶点个数（2-8个不等）周边剂量，中心剂量和剂量曲线，本组病例周边剂量为11-27Gy（平均20.3Gy)；中心剂量20-50Gy(平均40.5Gy)。结果 34例（73.9%)患者脑AVM完全闭塞，7例（15.2%)患者病灶明显缩小，病灶大小无变化者为6.5%(3例），2例（4.3%)术后脑AVM出血，无1例死亡，结论 血管内栓塞联合γ刀治疗脑AVM是安全有效的新手段。尤其适合脑AVM体积较大，位于重要功能区，手术难度大，患者不能耐受开颅手术者。     

颅内神经节细胞胶质瘤的临床表现、影像学特点及其预后分析（附18例报告）

目的探讨神经节细胞胶质瘤的临床表现、影像学特点、治疗方法及预后。方法回顾性分析18例神经节细胞胶质瘤患者的临床表现、影像学特点、治疗方法及随访结果。结果所有患者均行手术治疗,肿瘤全切16例,次全切除2例,复发1例,再次手术治疗。所有病例术后均随访2-6年,16例恢复正常工作和学习;14例术后癫痫缓解,3例需要服用药物控制癫痫。1例3年后复发,二次手术后恢复正常。结论神经节细胞胶质瘤预后相对良好,手术是目前其主要的治疗方法,早期发现,早期治疗,有助于提高患者生存质量和减少复发率。     

麻将癫癎（附9例临床报道）

目的:回顾分析麻将癫痫的临床表现。方法:从1996-2003年门诊求诊的9例麻将癫癎患者临床资料,随访记录及实验室资料进行分析。结果:本组9例患者均由玩麻将诱发癫癎发作(其中2例观看别人玩麻将发作),平均发病年龄(55.22±8.2)岁。6例患者以全身强直-阵挛发作,3例部分性发作继而全身发作。6例脑电图正常,1例局限性颞叶慢波,2例额颞部间歇性慢波活动。脑影像学(头颅CT或MRI)6例正常,1例有腔隙性梗死,2例脑萎缩。9例均无癫癎阳性家族史。9例行抗癫癎药物治疗均已控制。结论:麻将癫癎是反射癫癎的一种类型,可能在玩麻将时思考、紧张、制定决策等因素诱发。麻将癫癎容易控制,除用抗癫癎药物治疗外,避免玩麻将即可预防癫癎发作。     

伽玛刀治疗下丘脑错构瘤（附10例分析）

目的 观察伽玛刀治疗下丘脑错构瘤的效果。方法 回顾性分析近10年我院伽玛刀治疗的10例下丘脑错构瘤的临床资料。全部采用伽玛刀治疗,周边剂量10~17 Gy,平均13.3 Gy;等剂量曲线采用40%~55%。结果 随访2~10年,平均7.3年。有癫痫表现的9例,Engel分级Ⅰ级3例,Ⅱ级4例,Ⅲ级1例,Ⅳ级1例,治疗有效率为88.89%。性早熟2例,伽玛刀治疗无效。无并发症。结论 伽玛刀治疗是缓解下丘脑错构瘤癫痫症状的有效方法。     

Predictors of seizure control in patients with juvenile myoclonic epilepsy (JME)

PurposeJuvenile myoclonic epilepsy (JME) is a widely accepted epilepsy syndrome. Factors that are potentially predictive for seizure outcome in JME are not entirely clear yet. In the current study, we tried to identify factors that are potentially predictive for seizure outcome in patients with JME.MethodIn this case–control study all patients with a clinical diagnosis of JME were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 to 2012. All patients were followed for at least 18 months. We divided the patients into two groups: patients who were seizure free in the last 12 months of their follow-up period and those who had any seizures (i.e., generalized tonic-clonic (GTC), myoclonic or absences).Results116 patients were studied. Sixty-eight patients were seizure free in the last 12 months of their follow-up and 48 patients had at least one seizure of any type. Shorter follow-up period, drugs other than valproate in the drug regimen, and poor drug adherence were significantly more frequent among those who were not seizure free.ConclusionA correct diagnosis of JME does not guarantee an optimal response to therapy. Poorer drug adherence might result in more seizures; this should be highlighted for patients in every single visit. Longer follow-up gives the treating physician more time to adjust the drug(s) and formulate a plan that is appropriate for patients with difficult to treat seizures. We recommend valproate if seizure control is the main objective.